A study published in the November 19 edition of the New England Journal of Medicine documents a direct link between anti-HIV medications and cardiovascular risks, with antiretroviral drugs boosting the risk of heart attack by 26% per year of exposure to the drugs for the first four to six years of their use. Patients taking anti-HIV drugs had about double the risk for a heart attack after four years of treatment as did those just beginning antiretroviral therapy. The study included more than 23,000 patients, making it one of the largest research projects to date focusing on the cardiac risks of anti-HIV medications. It is also one of the first to clearly show a link between antiretroviral drugs and increased cardiac risks.
A total of 126 patients had a heart attack during the study. Study subjects who had been taking anti-HIV drugs the longest had the highest incidence of heart attacks. Other factors linked with boosted cardiac risks were older age, current or former smoking, high blood lipid levels, the presence of diabetes, and previous cardiovascular disease. Men also were at a higher risk for heart attacks than women.
The study says that the increased risk of heart attack is probably linked to a rise in cholesterol and triglyceride levels in the blood of patients on highly active antiretroviral therapy. The study findings are significant, the researchers say, because highly active antiretroviral therapy has significantly prolonged the lives of many HIV-positive people, leaving them vulnerable to other health risks like heart disease as they continue to age. But because the risk of heart attack was still relatively low compared with the immune-system-recovery effects of the medications, the researchers say doctors should weigh the cardiac risks against the significant advantages of anti-HIV drugs when considering putting their HIV-positive patients on HAART regimens.